CHRONIC PAINPREVENTING IT BEFORE IT STARTS

"It is estimated that 120 million adults in the United States suffer from chronic pain. Chronic pain conditions have become the most prevalent chronic conditions and the primary driver of health care, costing more than diabetes, cancer, and heart disease, and is the most common cause of work loss and disability. If initial efforts to improve pain fail, care often escalates to higher-cost, higher-risk passive interventions such as poly-pharmacy, implantable devices, injections, physical therapies, and surgeries. Most people who have pain that lasts longer than one month still have persistent pain 5 years later, despite extensive treatments." Cherry picked from the first two paragraphs of this month's issue of Practical Pain Management (Can We Prevent Chronic Pain?). Much of this article was based on 2011's Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

The paragraph above tells a story. CHRONIC PAIN is not only a colossal and costly problem in America, it is painfully obvious (no pun intended) that we are losing the battle. I am going to show you today that some of this is due to the fact that we have declared war on the wrong thing (we continue to chase symptoms instead of dealing with underlying causes).

In the paper the authors speak about risk factors for Chronic Pain (some that are mentioned include "DEPRESSION, POOR SLEEP, and MALADAPTIVE POSTURES". The problem is, I rarely see these being addressed other than drugs (HERE and HERE are two examples). The result is "POLY-PHARMACY, PHYSICAL THERAPY, INJECTIONS, and SURGERIES". The medical community is at least partly to blame for this. "Despite recognition that many of these factors can be improved with self-management strategies, they often are not addressed in routine care, leading to pain persisting for years." I'll address why they are not addressed in routine care momentarily.

The authors have a bold plan --- to stop Chronic Pain before it ever starts. Their hope is to accomplish this via something called a Human Systems Approach. Last January's issue of HHS Public Access (Human Factors Systems Approach to Healthcare Quality and Patient Safety) loosely defined this as a system of healthcare that emphasizes things like collecting patient data, patient education, REPORTING DRUG ERRORS, proper ergonomics, integrative care, and of course, EVIDENCE-BASED MEDICINE.

"Systematic reviews of biomedical treatments for chronic pain have found that even with the most efficacious treatments, improvement is only slightly above placebo."

In other words, we are spending hundreds of billions of dollars on treatments (discussed earlier, including "THE BIG FIVE") that are barely better than sugar pills. Gulp! What does the model that the authors suggest we replace this with (Human Systems Approach) look like? It sort of reminds me of the hobo's pie-in-the-sky-in-the-great-by-and-by Big Rock Candy Mountain. "Clinicians are to become agents of change. Combining evidence-based biomedical treatments with robust patient training to reduce risk factors and enhance protective factors can transform a person’s life from one beset by illness to one characterized by health and wellness. This is the basis for a transformative model of care. To prevent chronic pain, clinicians must evaluate and manage the whole patient. By not addressing underlying risk factors, medical treatment alone is unlikely to succeed long-term." I think it's a great idea, but foresee some potentially insurmountable roadblocks ahead.

If you have spent any time at all kicking the tires on my website, you'll quickly realize that this is what I try to do in my practice. I have any number of articles on any number of topics that I can send patients to. I use a unique approach to help people with their Chronic Pain (HERE). Plus, I always try and show patients that INFLAMMATION is at the root of their problem (even if their problem is the result of FIBROSIS / SCAR TISSUE) and can be successfully addressed in any number of ways that do not involve drugs. In fact, this issue of PPM had an article on the common link (Inflammation) between both ARTHRITIS and OBESITY. But here's the rub.

Firstly, even though the words "healthy diet" are mentioned in this article, "inflammation" is not. Both are huge mistakes. I have learned that vague terms like "healthy diet" can mean almost anything to patients. And unfortunately, it means EVEN LESS TO MOST PHYSICIANS. If the goal is stopping inflammation ---- THE ROOT OF NEALY ALL SICKNESS, PAIN, AND DISEASE --- in its tracks, diet is going to have to play a huge part. If doctors don't know much of anything about real nutrition (see first link in this paragraph), how in the world is this going to happen?

Secondly, even if the average physician knew and passed on mountains of information on nutrition, what makes anyone think that the average patient is going to follow it? We live in a country where even though people realize that things like SUGAR, SODA, JUNK FOOD, and CIGARETTES are all bad, as long as someone else is paying for their healthcare (the American taxpayer or those in their health insurance pool), a large percentage frankly don't care. How else do you explain ever-expanding rates of virtually all sickness and disease (Chronic Pain included), not to mention the fact that only 3 of 10 of us are of a normal weight?

Thirdly, do you really think that doctors have time for this sort of thing? Every doctor I know is stressed to the max, mired in bureaucratic BS, and completely bogged down with paperwork (HERE). They are constantly running behind, finding it virtually impossible to meet all the criteria that the government has piled on them. That's why your doctor visit consists of them looking at their computer and typing instead of paying attention to you. In a word, they are overwhelmed. A transformative type of healthcare would be fantastic, but the average doctor is not even taking care of himself / herself (HERE). How in the world are they going to transform their patients --- especially in a world where our talking-out-of-both-sides-of-our-mouth government is working against them on any number of fronts (HERE and HERE are a couple).

And lastly, how do we overcome the system we are currently bogged down in? Don't kid yourself people --- Big Pharma (they're the ones that actually control most of the field of medicine) doesn't want you healthy. THEY WANT YOU SICK! That way they can "manage" your diseases for the rest of your life. Pharmaceutically, of course. If you want to know who's pulling the healthcare strings in this country, just follow the money.

And as for the "integrated medicine" part of this shindig, I guess I'm not quite sure what that really means. Especially in relationship to an article run by the same journal last month (Interdisciplinary Rehabilitation: Information for Pain Practitioners ---- Understanding the Role of Epidurals, Nerve Blocks, Neurostimulation, and Osteopathic Manipulation can Help Improve Treatment and Alleviate Suffering). The author of the part on Osteopathic Manipulation (a DO himself) insinuated that manipulation by a DO is better than that from a DC because, "A chiropractor is not a licensed physician and has not completed residency training in a hospital......." He then turns around and says that only about, "6% of DOs surveyed reported treating more than 50% of their patients with OMT (Osteopathic Manipulative Therapy), whereas nearly one third reported using OMT on less than 5% of their patients." So; even though it's chiros who do something like 95% of the manipulative therapy here in America, we are supposed to believe that DO's do a better job? Just another example why real integrative care is a pipe-dream --- at least for the foreseeable future.

Again, the goals are noble. "By accomplishing these goals, we will be able to address the Institute for Health Care Improvement’s triple aim to improve the patient’s experience of care, enhance the overall health of the patient, and reduce the cost of health care." The goal of IHI is that, "everyone should get the best care and health possible." Certainly sounds good on the surface. But until we dramatically change the way we do things here in America (hint: there has to be some personal responsibility and consequences attached), this initiative isn't going anywhere. It will likely make its way to the pile of failed government initiatives that cost a bundle but didn't really do anything but feed the bureaucracy. Then we can start the next failed initiative.

So; to answer the question, "Can chronic pain be prevented?, maybe. It helps to be following THIS ADVICEbefore you get into trouble. However, life happens. Injuries occur. ACCIDENTS are called "accidents" for a reason. If you are one of those individuals who is already struggling to cope with Chronic Pain, begin creating your personalized EXIT STRATEGY today. If you are simply looking to prevent Chronic Pain in the future, you can undoubtedly do better than the suggestions in this article.

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Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).